Genetic Engineering Experiment Risk Assessment Form

Project & Researcher Information

Project Title Principal Researcher Name Email Institution / Department

Experiment Details

Objective Organism(s) Involved Gene(s) to be Modified/Inserted Genetic Engineering Method Proposed Start Date

Risk Assessment

Identified Hazards Containment Measures Potential Environmental Impact Potential Risk to Humans

Waste Disposal & Emergency Procedures

Waste Disposal Plan Emergency Procedures

Declaration

Name Date Signature